Navigating the Ethical Landscape of Artificial Womb Technology

By: Lexi Waite, Biology ‘26

Imagine being a mother in a quiet hospital room, when the doctor breaks the terrifying news: "Your baby is going to be born prematurely". Sadly, this is the fate for many parents with 1 in 10 babies being born preterm in the United States. In 2021, 14.8% of infant deaths were due to premature births, but with advancing medicine this can be changed [1]. Newly developed Artificial womb technology (AWT) allows babies that were born prematurely to be placed into a device filled with artificial amniotic fluid creating an environment for further gestation. While this technology has multiple potential benefits, ethical and moral questions need to be considered before AWT human trials. 

When evaluating the ethics of AWT, it is essential to understand its potential risks and benefits.. While an overarching benefit would be to allow for further development for premature babies, AWT also allows the fetus to engage in “social interaction” and “experience the benefits of connection with other human beings” [2]. Though the child itself will be placed in the artificial womb, it will be able to form connections with those around it, continuing the bonds that were developed in utero. This could be beneficial as these bonds can allow for the child to connect with its mother and foster a sense of safety even out of the womb. 

Although there are benefits for the child and parents, there are also risks that could harm the fetus while in the artificial womb. The artificial womb requires an “anticoagulant coating t[hat] mitigate[s] the high risk of blood clots.” [3]. While these preventative measures are beneficial, when using AWT there is still a significant risk of blood clots for the fetus. In addition to a high risk of clotting, it was also found in previous trials with fetal lambs there was the potential for sepsis which required screening for infections [3]. Infection could pose a serious complication that needs to be taken into account when understanding the potential risks that could come to a fetus that is being placed in the artificial womb. Before the implementation of AWT, further research needs to be conducted to understand the likelihood of these harms and how successful trials could be before experimenting with human babies. Physicians could also play a vital role in using their expertise to assess the safety of the new technology before human trials. Along with these physical risks and benefits, additional ethical questions that need to be answered. 

One ethical question that remains unanswered focuses on who has the right to determine if a fetus should be placed in an artificial womb. The predominant opinion suggests that the mother should determine the outcome: “her will should be respected regardless of whether the trial could be beneficial for the fetus” [4]. This idea is supported and expanded on with the idea that using AWT is initially the mothers decision, but “once the fetonate is being supported by AWT, decision making would become a shared parental responsibility” [5]. While consent from the mother is crucial, there are alternative viewpoints that suggest “informed consent of both parents must be obtained,” but if the use of AWT were to also benefit the mother, then “consent of only the pregnant person is required” [6]. It is thought that if a mother were at severe risk of continuing a pregnancy, her consent may be the only one needed to begin using AWT. Certainly, there will be differing viewpoints on this topic, but the ethics of consent is vital to decide prior to the birth of a premature fetus. 

The question of consent needs to be discussed further when evaluating who can give informed consent while ensuring parents understand the potential risks. Informed consent regarding AWT should require the parents to be “counseled about the options regarding not enrolling in the study and the potential harms and benefits of enrolling” [6]. This true sense of consent may be difficult to obtain as the “painful decisions and the details of the process will be especially hard for parents when the time is limited” making them feel “pressured by a sense of emergency” [6]. The circumstances under which parents would have to decide to utilize AWT would not allow for parents to rationally think through and understand all consequences making informed consent nearly impossible. One way to combat this barrier would be for physicians to identify potential premature pregnancies and facilitate these conversations about AWT before this heightened emotional state. This role could be crucial as physicians can guide and support parents through the risks and benefits of AWT and provide information as to what the journey using AWT could look like. This difficulty, along with the other ethical considerations, demonstrates the multiple conversations that need to be had before using AWT on humans. While this technology can change neonatal medicine, it is crucial for all parties, patients and physicians, to understand the dynamics and limitations of working with AWT. 

In conclusion, the emergence of artificial womb technology has begun to raise ethical considerations surrounding informed consent and the potential benefits and risks to the fetus. As this technology continues into human trials it is important for parents to understand the limitations that AWT could still have. Looking forward, it is important for physicians to understand their role such as informing parents and advocating for the safety of AWT before its use on human fetuses.

References

1. Prematurity Profile. (2024). March of Dimes, https://www.marchofdimes.org/peristats/tools/prematurityprofile.aspx?reg=99#:~:text=In%20addition%20to%20the%20health,19%2C944)%20of%20all%20infant%20deaths.

2. Romanis, E.C. (2018). Artificial womb technology and the frontiers of human reproduction: conceptual differences and potential implications. Journal of Medical Ethics, 44:751-755, https://jme.bmj.com/content/44/11/751.

3. Wozniak, P.S., Fernandes, A.K. (2021). Conventional revolution: the ethical implications of the natural progress of neonatal intensive care to artificial wombs. Journal of Medical Ethics, 47:54, https://jme.bmj.com/content/47/12/e54. 

4. Cavolo, A., Pizzalato, D. (2024). Ethical reflections on organizing the first human trial of artificial womb technologies. Prenatal Diagnosis, 1-7, https://doi.org/10.1002/pd.6521.

5. Felix R. De Bie, Sarah D. K., Sourav K. B.,Partridge E. (2023). Ethics Considerations Regarding Artificial Womb Technology for the Fetonate, The American Journal of Bioethics, 23:5, 67-78, 10.1080/15265161.2022.2048738.

6. Romanis, E.C. (2020). Artificial womb technology and clinical translation: Innovative treatment or medical research? Bioethics, 34: 392–402. https://doi.org/10.1111/bioe.12701.